Absolute phasic blood flow measurement in the brain using digital subtraction angiography.

RATIONALE AND OBJECTIVES: In this study, an angiographic method using first-pass distribution analysis was used for quantification of phasic volumetric blood flow. Studies were conducted in an angiographic perfusion phantom and in an animal model (rabbit) after intraarterial injection of contrast material. METHODS: Digital subtraction angiography and first-pass distribution algorithm were used to assess the absolute volumetric flow rates. The method, based on the conservation of contrast material in successive angiographic images, uses the videodensitometric information in the arterial bed. Measurements were made by summing the pixel values in the region of interest, covering the whole perfusion bed. A contrast pass curve was generated for a sequence of images to obtain instantaneous volumetric flow rates. RESULTS: Instantaneous and mean absolute volumetric flow measurements made in the angiographic perfusion phantom and the common carotid artery of the animal models correlated well with validation measurements made using ultrasound flowprobes. The measured (M) and known (K) flow rates in the carotid artery were related by M = 0.87 K + 2.50 mL/minute (r = 0.96, standard error of the estimate = 3.79 mL/minute, n = 25) and M = 0.92 K - 1.00 mL/minute (r = 0.98, standard error of the estimate = 4.04 mL/minute, n = 38) using the videodensitometric and entrance vessel calibration techniques, respectively. Conclusion. Results demonstrate the potential use of the first-pass distribution method in conjunction with digital subtraction angiography for measuring phasic arterial blood flow in vivo.

Geometric quantitative coronary arteriography. A comparison of unsubtracted and dual energy-subtracted images.

The application of dual energy (DE) subtraction techniques to quantitative coronary arteriography (QCA) has the advantage of removing the tissue signal surrounding the vessel profile. We have compared the performance of two geometric QCA algorithms on DE-subtracted and -unsubtracted images to determine, for each, if DE subtraction is advantageous. The two algorithms under study were an edge detection algorithm and a Fourier analysis-based algorithm. For each algorithm, linear regression analysis was performed of measured cross-sectional area (CSA) versus actual CSA of coronary vessel phantoms. The edge detection algorithm was found to have improved precision (P less than .05) when applied to the DE-subtracted images. The Fourier analysis algorithm, however, was not effected by the DE subtraction. Among the unsubtracted image results, the Fourier measurements were more accurate (P less than .05) than the edge detection measurements. We conclude that the benefits to edge detection QCA of DE tissue subtraction outweigh the disadvantages of increased image noise and possible misregistration artifacts. However, the Fourier algorithm is relatively insensitive to tissue signal variations.

Absolute cross-sectional area measurements in quantitative coronary arteriography by dual-energy DSA.

Recent studies have emphasized the limitations of conventional coronary angiography. These limitations include the lack of correlation between the severity of coronary stenosis as estimated from coronary angiograms and the actual severity of stenotic lesions measured in postmortem hearts. As a result, attempts have been made to quantitate luminal dimension more precisely. The application of quantitative digital subtraction angiography (DSA) in the assessment of coronary artery lesion dimension has been limited by cardiac and respiratory motion artifacts. We have reported previously on a motion-immune dual-energy (DE) cardiac mode in which kVp and filtration are switched at 30 Hz. To assess the potential advantages of a videodensitometric technique for quantification of absolute vessel cross-sectional area (CSA), three different quantitative coronary arteriography (QCA) algorithms were compared. The three algorithms under comparison were a videodensitometric (V) algorithm, which does not require any geometric assumption for absolute vessel CSA measurement, and videodensitometric (VC) and edge detection (ED) algorithms, which do require the assumption of circular cross-section for CSA measurements. A cylindrical vessel phantom (0.5-4.75 mm in diameter) and a crescentic vessel phantom, producing 25% to 90% area stenosis, were imaged over the chest of a humanoid phantom. The low- and high-energy images were corrected for scatter and veiling glare before energy subtraction. For CSA measurements in crescentic vessel phantoms, the V algorithm produced significantly improved results (slope = 0.87, intercept = 0.51 mm2, r = .95) when compared to the VC (slope = 1.05, intercept = 4.19 mm2, r = .75) and the ED (slope = 1.57, intercept = 5.21 mm2, r = .60) algorithms.

Quantitative dual-energy coronary arteriography.

Subtraction techniques for digital cardiac imaging have been hampered by misregistration artifacts. The use of dual-energy imaging is being evaluated as a means for reducing these artifacts. Results reported previously indicate that the dual-energy technique may be useful for applications such as exercise ventriculography and general quantification tasks. The purpose of the current study is to investigate the use of dual-energy subtraction imaging for quantitative coronary arteriography. In vivo coronary vessel phantoms (0.2 to 7 mm2 in cross-sectional area) were used to study the potential advantages of tissue suppressed energy subtracted images over unsubtracted images for quantification of absolute vessel cross-sectional area when cardiac motion is present. Estimates of lumen cross-sectional area (N = 20) were determined using videodensitometric analysis of selected energy subtracted and unsubtracted images. Linear regression analysis of measured and actual cross-sectional area showed energy subtracted image data (slope = 1.06, intercept = 0.48 mm2, r = 0.99) to have improved accuracy (P less than .05) and precision (P less than .05) over unsubtracted image data (slope = 1.24, intercept = 1.07 mm2, r = 0.95).

Quantification techniques for dual-energy cardiac imaging.

We have previously reported a motion immune dual-energy subtraction technique in which x-ray tube voltage and x-ray beam filtration are switched at 30 Hz between 60 kVp (2.0-mm Al filter) and 120 kVp (2.0-mm Al + 2.5-mm Cu filtration). In this paper we consider the suitability of these dual-energy images for quantitative measurements of iodine thickness and volume. Optimized iodine signal-to-noise ratio (S/N) was measured as a function of phantom thickness. Using a fixed mAs, the S/N of the dual-energy images was found to decrease by sevenfold as lucite thickness increased from 10 to 25 cm. For the same increase in lucite thickness S/N for time subtraction images decreased by fivefold. Image quality in two human volunteers was subjectively judged to be good. In order to quantitate physiological parameters such as ejection fraction and left ventricular volume, energy dependent corrections for scatter and veiling glare, beam hardening, detector nonuniformity, heel effect, and uncanceled bone signals were developed. Since the dual-energy technique does not completely cancel bone, a preinjection dual-energy subtraction image was used to estimate integrated bone contributions to iodine volume measurements. In a phantom measurement simulating exercise ventriculography, the known (Vk) and videodensitometrically measured (Vm) volumes of 19 mg/cm3 solution of iodine were related by Vm = 0.95 Vk + 1.50 cm3 (r greater than 0.99).

Scatter-glare corrections in quantitative dual-energy fluoroscopy.

Previous attempts to use time subtraction intravenous digital subtraction angiography for ventricular imaging have been hampered by artifacts due to cardiac and respiratory motion. We have previously reported a motion-immune dual-energy technique in which kVp is switched between 60 and 120, at 300-500 mA, 30 times/s. In order to quantitate parameters such as ejection fraction and left ventricular volume, it is necessary to correct for scatter and veiling glare (SVG), which are the major sources of nonlinearities in videodensitometric digital subtraction angiography (DSA). In this report, a convolution filtering method has been investigated to estimate SVG in DSA images. In the first step, a grey level transformation of the detected image is utilized to get an estimated SVG image. In the second step this image is convolved to produce an image with appropriate spatial frequency content. Estimates of SVG in several Humanoid chest phantom images were obtained using Gaussian convolution kernels with a full width at half-maximum (FWHM) of 51-125 pixels. The root-mean-square (rms) percentage error of these estimates was obtained by comparison with direct SVG measurement. A convolution kernel with a FWHM of 75 pixels in each dimension applied to 16 Humanoid phantom images with various projections, thicknesses, and beam energies resulted in an average rms percentage error of 9.7% in the SVG estimate, for the 16 cases studied. The SVG estimation consisting of grey scale-to-SVG fraction lookup table (LUT) is made based on previous measurements. The x-ray settings required for each patient are utilized to alter the LUT in order to account for patient thickness variations.(ABSTRACT TRUNCATED AT 250 WORDS)

Scatter radiation exposure during knee arthrography.

Knee arthrography, as performed at the authors' institution, was simulated and scattered radiation exposure to a radiologist's gonads, thyroid, and eye lens was measured with a sensitive ionization chamber. Results show that radiologists who regularly conduct knee arthrography examinations can incur doses to the gonads that are less than 6% of the U.S. limits, and to the thyroid and eye that are approximately 10% of the U.S. limits. Since the scatter radiation from overhead imaging of stress views constituted most (greater than or equal to 60%) of the dose to the lens of the eye and the thyroid, spot imaging was evaluated as a substitute for overhead imaging in the assessment of the anterior cruciate ligament. This substitution resulted in no loss of clinical information and has now completely replaced overhead imaging of stress views at this institution.